Provider Demographics
NPI:1790810596
Name:WONG, MATT SUN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:SUN
Last Name:WONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W EL CAMINO REAL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1632
Mailing Address - Country:US
Mailing Address - Phone:650-965-2225
Mailing Address - Fax:650-967-5328
Practice Address - Street 1:2290 W EL CAMINO REAL
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1632
Practice Address - Country:US
Practice Address - Phone:650-965-2225
Practice Address - Fax:650-967-5328
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78611Medicare UPIN
CADC023709Medicare ID - Type Unspecified